The current working definition as proposed by a working group from AASLD and EASL emphasized the occurrence of “cirrhosis” and “multisystem organ failure.”5 APASL recommended jaundice with serum bilirubin level >5 mg/dL as 1/2 mandatory criteria for diagnosis of ACLF.4 For our definition of ACLF, the cut-off level of serum bilirubin was 10 mg/dL, and cirrhosis and multiorgan failure were not taken as mandatory criteria, according to the Chinese guidelines.2,3 The latter explained why the serum creatinine and albumin were better preserved and the survival rate was higher in our patients. Here, ALB is linked to Cirrhosis.